Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | BP1-0029100 | TX |
Y | 2080P0201X | Pediatric Allergist | N7594 | TX |
NPI | 1568653756 |
---|---|
Provider Name | Dr. Amanda A Trott-Gregorio |
First Address | San Antonio, TX 78258-4076 |
Second Address | San Antonio, TX 78258-4076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 07/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1124399092 | NPI TYPE 2 GROUP (01) | TX |
4665454675 | MYUTMB 4665454675 (01) |